How do Americans know pharmacy-filled prescription bottles have not been tampered with?
Posted by bumblebee4all@reddit | AskAnAmerican | View on Reddit | 70 comments
In Europe I usually get sealed blister packs or manufacturer packaging. In the US, pharmacies seem to fill patient bottles from bulk stock via distributors, distribution centers, or mail-order pharmacies. What safeguards protect that chain?
Raelf64@reddit
For the love of God, shut up. We already have warning labels on everything, instructions on opening or eating things, please stop pointing stuff out for new tamper resistant packaging.
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pinaple_cheese_girl@reddit
I don’t see how it’s any safer to trust a blister pack; they could’ve tampered with it before putting it in the pack, unless it’s straight from the manufacturer, in which case someone there could’ve tampered with it as well, like the Tylenol murders.
The pill bottle has a description of the pill on it. I always make sure it matches the pill when I first open it. Otherwise, I just trust the pharmacist and techs
Acceptable_Mark7716@reddit
The pharmacist is responsible for the final verification. They identify the contents of the bottle by sight, smell, and other identifiers. United States pharmacists have doctorates and don’t mess around.
How do you know the pill in your blister pack is the correct pill? A pharmacist oversaw the packaging there, too. It’s the same thing.
Icy_Huckleberry_8049@reddit
when you pick it up at the pharmacy, who would be tampering with it?
pueraria-montana@reddit
In Europe they give you all the meds in blister packs, they don’t get pill bottles there
tetrasodium@reddit
That sounds like a huge pain in the ass to get 3 months of blister packs for multiple prescriptions
sweetbutcrazy@reddit
American blister packs are different and annoying to deal with. European blister packs are very easy to pop open and a 1 month prescription of my zyrtec is about an inch taller and wider than my pill bottles but they take up less space s because they can be stacked.
bearsnchairs@reddit
I think what you’re missing is that it a very common to bit bulk generics. If your 1 month blister pack is a bit larger than your pill bottle, a 12 month supply of blisters takes up significantly more space than a bottle with 365 pills.
CylonSandhill@reddit
Still a lot of single use packaging.
sweetbutcrazy@reddit
It's really not, american blister packs are very different and way more difficult to open (spent half my life there). The plastic bottles produce a lot more waste, release more microplastics and add a lot of unnecessary work and room for error. It's also more difficult to track how many pills you've taken. This is a 98 day pack for example, which is over 3 months, the entire thing is 3.5x2x1.5 inches, completely recyclable
https://www.amazon.de/-/en/ASPIRIN-Protect-100-Tablets-Pack/dp/B01KB7IUX0#cr-media-popover_1777455647582
pueraria-montana@reddit
There are no pictures of the internal blister pack, just the box
HistopherWalkin@reddit
Seems incredibly wasteful to have all that individual packaging.
sweetbutcrazy@reddit
It's paper and aluminum as opposed to putting pills that come in big plastic bottles into smaller plastic bottles
Equivalent-Speed-631@reddit
The majority of the time, when I fill a prescription, since I get 90 day supplies, the pharmacy just puts the label on the manufacturer bottle and gives that to me. It’s still sealed from the manufacturer.
I rarely see medication that comes from the manufacturer in blister packs for humans. For dogs, all the time.
notaskindoctor@reddit
I agree that it’s rare to see them in blister packs here. The one thing I do have like this is zofran (medication for nausea and vomiting), likely because the pills are very tiny and intended to dissolve in your mouth.
bearsnchairs@reddit
It is a market difference. Japan also has a strong preference for blisters.
Cheap_Coffee@reddit
Pill bottles are recyclable. Blister pack detritus goes in the trash.
Say_Hennething@reddit
How is the person operating the machines that put them in blister packs any more or less trustworthy than the person putting them in a bottle at the pharmacy?
At the end of the day, they are both exposed to the possibility of human tampering
Cheap_Coffee@reddit
Not very environmentally conscious, is it?
VirtualMatter2@reddit
You can get medicine mixed by the pharmacist in Europe. They are licensed to do so. Usually they don't, and likely not allowed for actual restricted drugs like fentanyl. But it's allowed.
kit-kat315@reddit
We have them in the US too. That's where I get some meds for my cat, since they do custom sized doses. Or less common liquid meds.
koreanforrabbit@reddit
We have those too. They're called "compounding pharmacies".
Capable-Sock9910@reddit
If you're worried about after it's been filled, ask them to use a bit of steritamp. Tamper-evident Tape
OpeningChipmunk1700@reddit
Tampered with by whom?
Minimum-Attitude389@reddit
The pharmacist or pharmacy technicians. They've been known to steal on occasion. I wouldn't be surprised if they would be willing to dilute certain medications. Particularly anything that's easily abused, like opioids.
Cheap_Coffee@reddit
Because the pharmacist hands the bottle to me when I pick up the meds, and no one else handles them.
What do you think is going on behind the counters of pharmacies?
JoganLC@reddit
You are trusting the people who made the pills at the lab didn't tamper with it before it got to the blister pack.
Electronic_Sky_207@reddit
Generally it’s fairly safe to trust your pharmacist. They have way too much to lose to risk stealing meds. But I’ve been in situations (picking up meds for a group home/handling controlled substances for family) where I asked the pharmacist/tech to count them in front of me and they’ve always been happy to do so. No one’s trying to short you on boring meds like statins. But it’s ok to double check on something “worth stealing” like opioids and stimulants.
stlcdr@reddit
There’s a higher level of justifiable trust in the US than other places.
EtchingsOfTheNight@reddit
When you get meds in hospital that aren't blister packs, how do you know those meds haven't been tampered with? At some point, even though malicious actors happen, you have to trust medical professionals to be professional.
1029394756abc@reddit
Why trust anyone anywhere. Do you cook all your own food. Do you trust the supermarket employee. Do you trust cooks in restaurants? Servers, bartenders?
ZaphodG@reddit
A machine fills my Rx and it’s then couriered to the pharmacy. The vast majority of prescriptions at my pharmacy are filled that way. The labor cost is too high to have a licensed pharmacist at the pharmacy count pills. The pharmacist is mostly doing 1-off Rx like antibiotics.
Designer-Sir2309@reddit
I don’t think you have a full understanding of how American pharmacies work or the medical licensing requirements. They are heavily regulated by the FDA which is no joke.
Even the tech who hands you the prescription had to go to school for 2 years and get licensed by the state and they have to renew that every 2 years.
Like fucking with your anti depressant just isn’t worth all that trouble. If I wanted to poison you there are easier ways.
Renny400@reddit
Pharmacists in the US are educated with a PharmD, (Doctor of Pharmacy degree) and they are well paid for their jobs. They’re not going to risk all that to tamper with anyone’s meds.
bangbangracer@reddit
When, and by whom?
Medications arrive at the pharmacy in sealed containers. If the tape is broken, tampering is evident. Any tampering would be at the pharmacy level.
pfizzy70@reddit
AND it's the same pharmacist/tech filling bottles as would be filling the blister packs, so if you're worried about the pharmacy, you worry about the blister packs as well. But if you trust your blister packs, you can also trust the vials that they fill for you.
____ozma@reddit
Are the blister packs not created by a pharmacist? Who's to say they aren't tampered with when created? It's just a different delivery method.
icyDinosaur@reddit
Pretty sure they are created in a pharma factory. I guess they could also mess with it there, but I'm assuming it's some mass production line that would be harder to interfere with?
(Personally that risk would not have crossed my mind either way tbh, but I could see a higher risk of mixups when someone has to manually fill a bottle compared to a factory line)
friskybiscuit14382@reddit
Only the pharmacists have access to the medication. Who would tamper with it?
Basic_Visual6221@reddit
You clearly haven't had enough experience with people if you're asking this question
Senior_Performer_387@reddit
Pharmacy techs help fill prescriptions.
WhereasLower3233@reddit
But they are still verified by a pharmacist before they ever go to a patient.
rando24183@reddit
Just because the pharmacy may be inside of a grocery store or convenience store like CVS does not mean it is operated by a typical grocery store worker. There people working there are licensed pharmacists and pharmacy techs. As the pharmacy may have different hours compared to the store it is in, the pharmacy is locked up separately when closed, often with a gate. So even if someone broke into the grocery store after hours, they would have to do another break in to get to the actual pharmacy.
I've never been concerned about some random person messing with my prescriptions just because it is in a bottle behind a locked gate and handled only by licensed professionals.
Zealousideal-Flow101@reddit
They are pretty good at catching health care workers who mess with drugs and they get better at it every day considering the surveillance state we live in. Most people have gone through some sort of effort to get a job in a pharmacy and don't feel like throwing that away.
TrashPandaNotACat@reddit
It's rare, but it does happen. See https://en.wikipedia.org/wiki/Robert_Courtney_(fraudster)
math1985@reddit
In my experience, the UK als so seems to follow the American system.
TravelKats@reddit
I get my medications via mail order and every pill bottle is sealed
Historical_Plant_956@reddit
Well, how would you know for sure that someone in the laboratory making the meds, or the factory assembling the blister packs, didn't tamper with your pills? Or any number of other, increasingly improbable possibilities?
I guess at a certain point you just have to trust people.
revdon@reddit
I work in pharmacy in a smallish city and many people get blister packs that are packaged locally, just like getting bottles filled.
The bulk drugs are sent to the local packaging facility and blister-packed after being sorted by pharmacy personnel.
So, what makes you think that blister packs are any safer than pill bottles?
TehWildMan_@reddit
They don't leave my pockets once I've obtained them. Ever.
burlingk@reddit
The US method is pretty common throughout the world actually.
agate_@reddit
This is only done for medications stored and sold "behind the counter". Anything on the shelves comes in a sealed tamper-evident bottle or blister pack.
The area behind the pharmacist's counter is a highly secure area staffed by trained professionals. If an unauthorized or unethical person could get in there, sure they could mess with your prescription, but they could also steal a few kilograms of opioids.
MsPooka@reddit
Pharmacists are medical professionals, who at the end of the day, you have to trust. Tampering with drugs is a serious crime, and it's a crime that could happen even with blister packs if someone was determined enough to do it. It has happened, especially with opioids, but it's also extremely rare. In the pharmacy, there are cameras, inventories, and many things do come as full bottles or blister packs. Stuff like blood pressure medicine or antibiotics come from a large bottle, which are all cheap and common and no one is stealing BP meds. It's a mix but even you need to just trust the pharmacist. They're extremely well trained, well educated, and licensed.
Rourensu@reddit
Someone clearly hasn’t seen Deadpool & Wolverine
huazzy@reddit
Not to mention they would lose their license, which would be crazy considering how much time/effort they probably spent acquiring it.
I'm sure it happens, but it just seems counterintuitive.
CountChoculasGhost@reddit
Every medication I get comes in a factory sealed containers. Either blister packs or sealed bottles.
There absolutely are prescriptions you get in unleaded bottles, but the only people that touch those are the pharmacists.
CandidateHefty329@reddit
This isn't a concern.
Jaded-Lifeguard-9856@reddit
At the pharmacy, medications are stored in locked shelving units until the person arrives for pick up
Satsuki7104@reddit
Not necessarily depending on what pharmacy and where. Mine has the large industrial sized bottles on shelves in the pharmacy section that is behind a locked counter for the normal meds, refrigerators for the cold ones, and a lock box for the controlled substances. The normal meds get filled and put in stapled shut bags with the patients info and put in sorted bins by patient name. They stay in the separated baskets until they’re picked up. The cold and controlled ones get handled as the patient goes to the counter for them.
DrBlankslate@reddit
The pharmacy is trustworthy. A pharmacist who lets tampered medications go through to consumers will very likely lose their job and their licensure. It's not a small thing.
lorazepamproblems@reddit
I myself would prefer not introducing that extra layer to distribution that destroys traceability for the patient.
It is somewhat odd that people can be so particular about sodas where they choose between Diet Coke, Coke Zero, Classic, along with every other manufacturer of sodas, and every single can has a lot number, expiration date, and manufacturing location, but if a patient has questions/preference about where a medication was made, they're considered a nut. Pharmacy is very much a commodities industry since generics came around. Congress pushes the FDA to approve generics, and I think that's led to the cheapness associated with pharmacies (cheapness in terms of the experience, quality of the product, and not modernizing with traceability including using blister packs or manufacturer's original packaging). It's very much not a consumer-centered industry compared to virtually every other product people ingest, where they want to know where it was made, if it's organic, etc. The way pharmacies receive medications from whichever manufacturer was cheapest at a particular point in time is almost like a farmer receiving feed in bulk without great concern for the integrity and then doling it out. The manufacturers are constantly buying each other or buying the rights to others' products, and it's entirely about volume and not consumer brand recognition. You go to a drug manufacturer's web-site and you can see it's geared toward shareholders. I think that trickles down to how the product is distributed.
I know in Europe generic drugs are often sold with the name of the manufacturer as part of the overall product name. That doesn't happen in the US. You might have tablets from one manufacturer one month and from another the next, and they're all just filled into the same amber vials, with no name distinction based on manufacturer. I think the attention in Europe to tying a product to its manufacturer may have something to do with the discrepancy in how they're distributed.
But in terms of what does exist, retail pharmacies have cameras, so it's not likely a pharmacy employee would risk adulterating the drug supply knowingly. For mail order, I suppose it's just reliance on there not being enough incentive to mess with the meds? It seems like it would take a lot of effort and a lot of risk.
I think the larger issue is not so much that the supply chain would be tampered with, though that could happen, but the overall quality of the medications and lack of testing of the finished product by any governing body. And I don't know how different that is in Europe from the US.
pueraria-montana@reddit
I don’t think the pharmacy tech is going to fuck with my Zoloft, she just wants to go home and watch Invader Zim
notapunk@reddit
Sure a pharmacist could tamper with it, but why would he risk a good paying job and their freedom after going to school that long?
just_a_wolf@reddit
The safeguards are that pharmacists are medical professionals and have massive legal liability. I have no reason to worry about what they're dispensing any more than I have reason to worry if my needles are clean when I'm getting a shot. Drugs are heavily regulated and tracked at every step between production, transport, and distribution. The only thing I trust people to be more motivated to keep watch on is actual money.
blablahblah@reddit
I don't think about it, just like I generally don't worry when my restaurant food comes out without sealed packaging.
If I was concerned, the label includes sufficient information for me to look up the drug and further out what size, shape, color, and marking the pills are supposed to be.
And if whatever drug smuggling ring is tampering with my meds is good enough to replicate all of that, I don't think a blister pack would save me.
manokpsa@reddit
You pick the prescription up from the pharmacy, or they're packaged and mailed to you. The technicians are supervised by a licensed pharmacist, and they have laws and procedures to follow. This sounds like asking how you know the nurse or physician doesn't tamper with the meds they're putting into your IV while you're in the hospital. You don't. You trust that they're professionals who want to keep their jobs, though.
Informal_Persimmon7@reddit
Pharmacies are very secure. Tons of laws in place too. It's not worth it for them to do anything bad with RXs and wind up in prison.
Adorable_Dust3799@reddit
I get mine mailed and there's a seal under the cap. If i pick it up at the pharmacy they fill the bottle and hand it to you. OTC meds are usually double sealed.
CaptainPunisher@reddit
Filled prescriptions are handled by licensed pharmacists and medically trained staff. It's really not worth it for them to do something that would cost them, not only their immediate jobs, but also their certification, licensure, and livelihood. They're trained professionals.
But, how do we KNOW? We don't. We trust that the advice is true and that they want to remain in good standing. Similarly, you don't KNOW that the stuff in blister packs isn't bad or improperly mixed. Things happen. You're simply trusting a pharmaceutical company to not screw things up.
For over the counter stuff like aspirin, morning, cough syrup, etc, they come with tamper-evident seals that will show if somebody messed with them. Still, we're trusting that the company got everything right. We still don't absolutely KNOW that it's right.